Appendicitis is an inflammation of the vermiform appendix (appendix) of the caecum. Typical symptoms are pain in the right lower abdomen accompanied by nausea or fever. Appendicitis usually becomes acute within a few hours. Due to possible complications such as circulatory disorders, sepsis (blood poisoning) or perforation (bursting) of the inflamed appendix, it is usually surgically removed as soon as possible. Chronic or subacute appendicitis can also be treated with antibiotics.
Overview
The appendix is in the right lower abdomen. It forms a 6 to 12 cm long intestinal tube at the beginning of the large intestine, coming to a dead end in the vermiform appendix (generally known simply as the appendix). Residues of food or faeces and bacteria can accumulate there. This accumulation can lead to the development of inflammation, usually manifested by acute pain in the lower right abdomen, accompanied by fever and nausea.
Appendicitis can cause serious and sometimes life-threatening complications. For this reason, if there is a well-founded suspicion of appendicitis, surgery should be carried out as soon as possible.
Causes and risk factors
Appendicitis is one of the most common types of intestinal inflammation requiring treatment, affecting about 1 in 1 000 people per year. In most cases, there is no specific cause that can be identified as the trigger for appendicitis. It is thought that it may be due to food residues or stool particles that have been deposited in the appendix. Occasionally, fruit stones such as cherry stones are blamed.
There are several risk factors that can increase the risk of appendicitis, including:
Age
Appendicitis can occur at any age in principle, but in fact it occurs most frequently during adolescence and early adulthood.
Gender
Men and women have different levels of risk for appendicitis. Men are at higher risk, as about 9 percent of them will experience acute appendicitis during their lifetime, while for women the risk is about 7 percent.
Nutrition
A diet high in roughage and fibre, which stimulates intestinal activity and promotes digestion, reduces the risk of appendicitis, while a diet low in these nutrients may increase the risk.
It is important to note that these factors may increase the risk but do not necessarily cause appendicitis.
Uncomplicated appendicitis
Uncomplicated appendicitis, the most common form of appendicitis, describes the inflammation of the appendix. Typical symptoms are sudden pain in the upper abdomen, which increases over some hours and travels to the right lower abdomen, accompanied by nausea or fever. Although it is now considered possible that this form can clear up on its own, in most cases the appendix is removed by surgery to prevent complications arising.
Bursting of the appendix (perforation)
If the inflammation spreads to neighbouring tissue, the appendix may perforate. Through the hole in the intestinal wall created by the perforation, fluid from the wound, bacteria and pus can enter the abdominal cavity, which can lead to life-threatening peritonitis and usually results in emergency surgery. Symptoms such as a hard abdominal wall, a curled-up relieving posture, paleness, increased heart rate and light-headedness, indicate that the inflamed appendix has burst.
Chronic appendicitis
Occasionally, the appendix can become chronically inflamed and cause long-lasting or recurring symptoms. Chronic or subacute appendicitis can also be treated with antibiotics. If the chronic inflammatory phases occur repeatedly, surgical removal of the appendix is recommended in most cases.
Symptoms
Appendicitis typically starts with pain in the upper abdominal area or near the belly button. This pain later moves to the right lower abdomen and becomes severe. Later, additional symptoms may occur, such as nausea and vomiting, constipation, and occasionally diarrhoea, fever and loss of appetite.
If the appendix perforates, additional symptoms such as a hard stomach wall, a curled-up relieving posture, increased heart rate, light-headedness or loss of consciousness occur. If a ruptured appendix is suspected, it is important to seek medical help immediately.
Physical examination
During the physical examination, the doctor will palpate the abdomen and check for painful reactions when pressing on certain areas.
Blood test
A blood sample is taken to measure the levels of inflammatory markers in the blood.
Ultrasound examination (Sonography)
An ultrasound examination is carried out to determine whether the appendix has changed or whether pus has formed.
Treatment
Treatment of acute appendicitis is usually carried out within 24 hours of diagnosis by either laparoscopic or open appendectomy.
To remove the inflamed appendix, laparoscopic surgery is generally preferred. In this minimally invasive procedure, surgical instruments and a camera are inserted into the abdomen through thin tubes. With the surgeon viewing the procedure via a camera, the appendix is then exposed and removed.
Open surgery is occasionally required, especially if the inflammation has already spread. This requires an approximately 6 cm long incision in the right lower abdomen.
In cases of uncomplicated appendicitis, surgery can sometimes be dispensed with and antibiotics constitute the sole treatment. However, there is an increased risk of re-inflammation of the appendix.
Prevention
In general, no specific preventive measures are known to prevent appendicitis. However, a diet rich in fibre can stimulate intestinal activity and promote digestion, thus reducing the risk.
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